Not applicable.
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Reference to a xe2x80x9cComputer Listing Appendix Submitted on a Compact Discxe2x80x9d
Not applicable.
(1) Field of the Invention
The present invention relates to a method for treating maxilla/cranial base to mandibular axis discrepancies in the temporomandibular joints (TMJs) of a patient such as is caused by mandibular, temporomandibular dysfunction syndrome (MTDS) or developmental facial/dental deformities without performing open jaw joint surgery. The method includes (1) repositioning the patient""s mandible into a stable relationship with the cranial base using a craniomandibular orthopedic repositioning orthotic which over time deprograms the patient""s jaw into the stable mandible to cranial base relationship; (2) constructing a model of the patient""s mouth on an artificial jaw simulator which replicates the patient""s jaw joint true hinge axis of rotation in the repositioned and stabilized mandible to cranial base relationship; (3) planning a surgical procedure comprising total maxillary osteotomy on the model which substantially treats the MTDS or developmental facial/dental deformities; and (4) performing the surgical procedure on the patient based on the surgical procedure planned on the model to treat the discrepancies.
(2) Description of Related Art
The surgical treatment of mandibular, temporomandibular dysfunction syndrome (MTDS) or developmental facial/dental deformities traditionally has centered on surgical manipulation of the jaw joint structural components: disc, ligaments, and tendons using open arthrotomy, arthroscopy, or partial or total jaw joint replacement. The fundamentals of oral and maxillofacial surgical procedures are standard and have been described in many texts on surgical techniques. For example, see Atlas of Oral and Maxillofacial Surgery (Keith ed., W. B. Saunders Company, Philadelphia, (1992) pp. 201-216). In general, these surgical procedures are performed with the jaw joints in an acquired bite or position of maximum intercuspation of the teeth without reference to the relationship of each mandibular condyle to its socket of the glenoid fossa and without any attempt to place each mandibular condyle in any stable, verifiable, and reproducible position in its socket of the glenoid fossa. Furthermore, the surgical procedures for treating MTDS or developmental facial/dental deformities are not generally planned on a model of the patient""s jaw joint in which the model has replicated the patient""s true hinge axis of rotation in the stable condylar position. Because the mandible condyles are not stably positioned within their sockets, the mandible to cranial base relationship remains unstable. Therefore, following a standard surgery for treating MTDS or developmental facial/dental deformities, the unstable relationship between the mandible and cranial base over time tends to develop into MTDS. As long as the relationship between the mandible and cranial base remains unaddressed in the standard surgical treatments for MTDS or developmental facial/dental deformities, the unstable relationship will remain and most likely render the surgical treatment merely temporary in effect.
Therefore, there is a need for a surgical method for treating MTDS or developmental facial/dental deformities in a patient wherein the method restores a functional bite to the patient while maintaining the patient""s jaw joint in its stable condylar position. In particular, there is a need for a method wherein the surgery to treat the MTDS or the developmental facial/dental deformities is planned on a model which replicate""s the patient""s true hinge axis of rotation in which the mandibular condyles are in a stable condylar position.
The present invention provides a method for treating maxilla/cranial base to mandibular axis discrepancies in the temporomandibular joints (TMJs) of a patient such as is caused by mandibular, temporomandibular dysfunction syndrome (MTDS) or developmental facial/dental deformities without performing open jaw joint surgery. The method includes (1) repositioning the patient""s mandible into a stable relationship with the cranial base using a craniomandibular orthopedic repositioning orthotic which over time deprograms the patient""s jaw into the stable mandible to cranial base relationship; (2) constructing a model of the patient""s mouth on an artificial jaw simulator which replicates the patient""s jaw joint true hinge axis of rotation in the repositioned and stabilized mandible to cranial base relationship; (3) planning a surgical procedure comprising total maxillary osteotomy on the model which substantially treats the MTDS or developmental facial/dental deformities; and (4) performing the surgical procedure on the patient based on the surgical procedure planned on the model to treat the discrepancies.
Therefore, the present invention provides a method for treating maxilla/cranial base to mandibular axis discrepancies in the temporomandibular joints of a patient comprising (a) fitting an orthotic to the maxillary teeth of the patient so as to allow full coverage of all the maxillary teeth, wherein the orthotic has an anterior ramp to provide anterior guidance of the patient""s mandible in excursive movements by contact of the superior surface of the anterior mandibular teeth of the patient with a posterior surface of the anterior ramp of the orthotic so as to allow for complete disclusion of the posterior mandibular teeth of the patient from the orthotic during eccentric jaw movements which over time deprograms the temporomandibular joints of the patient into a stable condylar position by stabilizing the condyles in their corresponding glenoid fossa sockets in the maxilla/cranial base;
(b) determining alignment of the mandible to the maxilla/cranial base in the temporomandibular joints of the patient after each condyle has been stabilized in its corresponding glenoid fossa socket by the orthotic;
(c) constructing a model of an upper dental arch of the patient with a base, which is parallel on all sides to the upper dental arch model and is delineated with horizontal and vertical reference lines, and a model of a lower dental arch of the patient with a base, which is parallel on all sides to the lower dental arch model and is delineated with horizontal and vertical reference lines;
(d) mounting the base of the upper dental arch to an upper plate with mounting stone of an artificial jaw simulator and mounting the base of the lower dental arch to a lower plate with mounting stone of the artificial jaw simulator such that the true axis of rotation of the temporomandibular joints of the patient with the temporomandibular joints in the stable condylar position has been maintained and wherein the sides of each base are parallel and confluent to the artificial jaw simulator mounting plates;
(e) determining on the artificial jaw simulator mounted with the upper and lower dental arch models an amount of maxillary bone to be removed from the patient""s maxilla in a surgical procedure wherein the maxilla is cut along a transverse plane superior to the maxillary teeth to separate the maxilla into an upper and a lower part which is sufficient to allow a jaw position in the patient when the upper and lower parts are joined after the amount of maxillary bone has been removed wherein the maxillary and mandibular teeth of the patient are re-approximated into a position coincidental to the stabilized jaw joint position with a functional bite wherein the anterior maxillary teeth provide anterior guidance of the mandible in excursive movements by contact of the lingual surface of the anterior maxillary teeth with the superior surface of the mandibular anterior teeth while allowing complete disclusion of the posterior maxillary and mandibular teeth during eccentric jaw movements and which at the same time maintains the temporomandibular joints in the stable condylar position;
(f) constructing a surgical stint of the functional bite in which the temporomandibular joints are in the stable condylar position to act as a guide for relating the maxilla to the mandible during the surgical procedure for removing the amount of maxillary bone from the patient determined in step (e);
(g) fitting the surgical stint into the mouth of the patient and performing the surgical procedure for removing the amount of maxillary bone from the patient""s maxilla determined in step (e); and
(h) immobilizing the patient""s jaw following the surgical procedure with the surgical stint fitted to the patient""s teeth so as to maintain the functional bite wherein the temporomandibular joints are in the stable condylar position and fixating the patient""s mouth shut for a time sufficient for the upper and lower parts of the maxilla to heal, which treats the cranial base to the mandibular axis discrepancies in the temporomandibular joints.
In a further embodiment of the method, the surgical procedure further includes an interim surgical procedure selected from the group consisting of widening the patient""s mandible, widening the patient""s maxilla, retruding the patient""s mandible, advancing the patient""s mandible, retruding the patient""s maxilla, advancing the patient""s maxilla, and combinations thereof and an intermediate surgical stint is made to act as a guide for relating the maxilla to the mandible during the interim surgical procedure.
In a further embodiment of the above methods, the temporomandibular joints of the patient are stabilized by sequentially fitting orthotics to the patient""s mouth wherein the anterior ramp of each orthotic in the sequence has been progressively elongated or wherein the orthotic is modified by elongating the anterior ramp or reducing the thickness of the orthotic covering the posterior maxillary teeth when needed to maintain complete disclusion of the posterior maxillary and mandibular teeth of the patient during eccentric jaw movements during the period of time for deprogramming the temporomandibular joints into the stable condylar position.
The present invention further provides a surgical method for treating the cranial base to mandibular axis discrepancies in a patient comprising:
(a) constructing a model of an upper dental arch of the patient with a base, which is parallel on all sides to the upper dental arch model and is delineated with horizontal and vertical reference lines, and a model of a lower dental arch of the patient with a base, which is parallel on all sides to the lower dental arch model and is delineated with horizontal and vertical reference lines;
(b) mounting the upper dental arch to an upper plate with mounting stone of an artificial jaw simulator and mounting the lower dental arch to a lower plate with mounting stone of the artificial jaw simulator such that the true axis of rotation of the temporomandibular joints of the patient with the temporomandibular joints in the stable condylar position has been maintained and wherein the sides of each base is parallel and confluent to the artificial jaw simulator mounting stones;
(c) determining on the artificial jaw simulator mounted with the upper and lower dental arch models an amount of maxillary bone to be removed from the patient""s maxilla in a surgical procedure wherein the maxilla is cut along a transverse plane superior to the maxillary dentition to separate the maxilla into an upper and a lower part which is sufficient to allow a jaw position in the patient when the upper and lower parts are joined after the amount of maxillary bone has been removed wherein the dentition of the patient is re-approximated into a functional bite wherein the anterior maxillary teeth provide anterior guidance of the mandible in excursive movements by contact of the lingual surface of the anterior maxillary teeth with the superior surface of the central and lateral incisors while allowing complete disclusion of the posterior maxillary and mandibular teeth during eccentric jaw movements and which at the same time maintains the temporomandibular joints in the stable condylar position;
(d) constructing a surgical stint of the functional bite in which the temporomandibular joints are in the stable condylar position to act as a guide for relating the maxilla to the mandible during the surgical procedure for removing the amount of maxillary bone from the patient determined in step (c);
(e) fitting the surgical stint into the mouth of the patient and performing the surgical procedure for removing the amount of maxillary bone from the patient""s maxilla determined in step (c); and
(f) immobilizing the patient""s jaw following the surgical procedure with the surgical stint fitted to the patient""s teeth so as to maintain the functional bite wherein the temporomandibular joints are in the stable condylar position and fixating the patient""s mouth shut for a time sufficient for the upper and lower parts of the maxilla to heal, which treats the cranial base to the mandibular axis discrepancies in the temporomandibular joints.
In a further embodiment of the method, the surgical procedure further includes an interim surgical procedure selected from the group consisting of widening the patient""s mandible, widening the patient""s maxilla, retruding the patient""s mandible, advancing the patient""s mandible, retruding the patient""s maxilla, advancing the patient""s maxilla, and combinations thereof and an intermediate surgical stint is made to act as a guide for relating the maxilla to the mandible during the interim surgical procedure.
The present invention further provides a method for stabilizing the condylar positions in the temporomandibular joints of a patient with temporomandibular dysfunction syndrome comprising:
(a) providing an orthotic to the maxillary teeth of the patient so as to allow full coverage of all the maxillary teeth, wherein the orthotic is designed with an anterior ramp to provide anterior guidance of the patient""s mandible in excursive movements by contact of the superior surface of the mandibular anterior teeth of the patient with a posterior surface of the anterior ramp of the orthotic so as to allow for complete disclusion of the posterior mandibular teeth from the orthotic of the patient during eccentric jaw movements which enables deprogramming the temporomandibular joints into stable condylar position;
(b) fitting the orthotic into the patient""s mouth for a period of time sufficient to deprogram the temporomandibular joints into the stable condylar position;
(c) modifying the orthotic when needed to maintain complete disclusion of the posterior maxillary and mandibular teeth of the patient during eccentric jaw movements during the period of time for deprogramming the temporomandibular joints into the stable condylar position; and
(d) measuring during the period of time for deprogramming the temporomandibular joints into the stable condylar position pain caused to the patient by the temporomandibular dysfunction, reproducibility of the patient""s bite on the orthotic, neuromuscular tension of the patient""s facial muscles, and the patient""s condylar position indices, wherein the condylar positions in the temporomandibular joints of the patient are determined to be stabilized when the patient is free of the pain and has a reproducible bite on the orthotic, there is complete release of neuromuscular tension whereby the patient""s facial muscles upon palpation show no signs of guarding, splinting, or tension, and the patient""s condylar position indices are less than about 1 mm.
The present invention further provides an apparatus for planning a surgical method for treating the cranial base to mandibular axis discrepancies in a patient comprising an artificial jaw simulator including an upper member with a downwardly facing surface and having a pair of spaced sockets at one end, which represent the sockets of the patient""s glenoid fossae, pivotally mounted on a pair of spaced spherical styluses, which represent the simulated horizontal or hinge axis of the patient""s condyles, on a frame vertically mounted on one end of a lower member with an upwardly facing surface, and a model of an upper dental arch of the patient with a base, which is parallel on all sides to the upper dental arch model and is delineated with horizontal and vertical reference lines, mounted with a separating media to a mounting stone mounted on an upper plate which is mounted to the downwardly facing surface of the upper member of the artificial jaw simulator, and a model of a lower dental arch of the patient mounted on a mounting stone, which is parallel on all sides to the lower dental arch model and is delineated with horizontal and vertical reference lines, mounted using a settable material on a lower plate which is mounted to the upwardly facing surface of the lower member of the artificial jaw simulator, wherein the relative motion between the upper and lower plates with the models mounted thereon is the same as the relative motion between the patient""s upper and lower jaws, and wherein the true axis of rotation of the temporomandibular joints of the patient have been maintained.
The present invention further provides an orthotic for stabilizing the condylar positions in the temporomandibular joints of a patient with temporomandibular dysfunction syndrome comprising a base portion with an upper and a lower surface, an anterior and posterior surface, and having a generally U-shaped plan form and including opposite integrally formed side arms adapted for location between the orthotic and mandibular teeth of the patient, the base having an inner flange along its trailing edge and an outer flange along its leading edge wherein the inner flange and outer flange extend upward from the base so as to form a channel for accepting the maxillary teeth of the patient wherein the bottom surfaces of the maxillary teeth are in contact with the surface of the channel, and wherein the width of the channel is adapted to the width of the maxillary teeth of the patient, and wherein the base has a vertical thickness sufficient that when the maxillary teeth are engaged in the orthotic there is complete disclusion of the posterior maxillary and mandibular teeth during eccentric jaw movements, and wherein the thickness of the base in the position where the anterior maxillary teeth are engaged defines a downwardly extending ramp with anterior and posterior surfaces of sufficient thickness to allow the superior surface of the central and lateral incisors to glide freely along the posterior surface of the ramp to simulate the guidance of normal central and lateral incisors against the lingual surface of normal anterior maxillary teeth in a condition of no wear and normal vertical anatomy and to provide anterior guidance of the patient""s mandible in excursive movements by contact of the superior surface of the central and lateral incisors with the posterior surface of the ramp so as place the posterior maxillary and mandibular teeth out of contact.
The present invention further provides an orthotic for maintaining the mandible to maxilla/cranial base alignment and stability in the temporomandibular joints of a patient during or following a surgery which verifies stable condylar position in the temporomandibular joints of the patient comprising a base portion having a generally U-shaped plan form and including opposite integrally formed side arms adapted for location between the maxillary and mandibular teeth of the patient, the base having an inner flange along its trailing edge and an outer flange along its leading edge and extending upward and downward from the base so as to form an upper channel for accepting the maxillary teeth and a lower channel for accepting the mandibular teeth of the patient and which when fitted to the patient""s teeth maintains the mandible to maxilla/cranial base alignment and stability in the temporomandibular joints of the patient.
Objects
It is an object of the present invention to provide a method for treating maxilla/cranial base to mandibular axis discrepancies in the temporomandibular joints of a patient such as is caused by MTDS or developmental facial/dental deformities without performing open jaw joint surgery.
It is a further object of the present invention to provide a method for treating maxilla/cranial base to mandibular axis discrepancies in the temporomandibular joints of a patient such as caused by MTDS or developmental facial/dental deformities by performing total maxillary osteotomy either alone or in conjunction with mandibular osteotomy.
It is a further still object of the present invention to provide a method for treating maxilla/cranial base to mandibular axis discrepancies in the temporomandibular joints of a patient such as those caused by MTDS or developmental facial/dental deformities wherein the surgical procedure for treating is planned on a model of the patient""s mouth wherein the true axis of rotation of the patient""s jaw joint in a stable condylar position has been replicated.
These and other objects of the present invention will become increasingly apparent with reference to the following drawings and preferred embodiments.